Signing Intoxicated students

[fiznat]

they take those substances specifically to ALTER their mentation/perception of reality. With that in mind, how CAN they refuse if they are under the influence of them? From my own experience, those who have taken drugs (not specifically ETOH, sorry for the hijack) DO show they are under the influence and are not able to make rational decisions for themselves.

This is a logical and legal nightmare. How are we as prehospital providers capable of making a judgment about a patient's motivations for consuming an intoxicant? Not only would such a conclusion prove absolutely worthless on it's face for lack of clinical evidence, it is also completely irrelevant when assessing a patient's mental status.

Is the patient who took a placebo by mistake altered because we suppose he had intended to take the real drug?

Is the patient who was speeding in his car guilty of an assumed suicidal motive and deserving of a psychiatric committal?

The fact is, NONE of this matters except the patient's presentation at the moment of the assessment. If the patient is alert and oriented and capable of making a sound decision for him/herself, then the case is closed. I don't transport patients against their will unless the situation TRULY demands it in the face of an emergency. This is not it.

[Arizonaffcep]

Is the patient who was speeding in his car guilty of an assumed suicidal motive and deserving of a psychiatric committal?

Once in a while...just hope they don't take anyone else out! :roll:

The fact is, NONE of this matters except the patient's presentation at the moment of the assessment. If the patient is alert and oriented and capable of making a sound decision for him/herself, then the case is closed. I don't transport patients against their will unless the situation TRULY demands it in the face of an emergency. This is not it.

There is a clause in the protocols that says ultimately, it's up to the medic who is providing care. I have seen it go either way. I can see the point on both sides of the argument. Then again, I've also had the patient who has just done some meth, A&O x4, talking coherently and carrying on a good conversation. I got him to refuse...and he promptly ran across the street and got tagged by a car in the process. My wrist got slapped because I let him refuse. It's the unpredictability of the drugs and patient that carry the concern, and the rather rapid "shift" they can have between rational and irrational.

[reaper]

Once in a while...just hope they don't take anyone else out! :roll:

There is a clause in the protocols that says ultimately, it's up to the medic who is providing care. I have seen it go either way. I can see the point on both sides of the argument. Then again, I've also had the patient who has just done some meth, A&O x4, talking coherently and carrying on a good conversation. I got him to refuse...and he promptly ran across the street and got tagged by a car in the process. My wrist got slapped because I let him refuse. It's the unpredictability of the drugs and patient that carry the concern, and the rather rapid "shift" they can have between rational and irrational.

I could refuse a jogger that twisted their ankle. They could leave, cross a street and get tagged by a car. Same scenario! How is that my fault?

Did you do a blood test on that pt? How do you know he just did meth? If the pt is competent and A&Ox4, they have the right to refuse!

[Arizonaffcep]

I could refuse a jogger that twisted their ankle. They could leave, cross a street and get tagged by a car. Same scenario! How is that my fault?

Did you do a blood test on that pt? How do you know he just did meth? If the pt is competent and A&Ox4, they have the right to refuse!

I did a FSBS, normal, and he admitted to the meth. They were not happy because I refused a person who had taken meth, and should have transported because it was "mind-altering." But yes, he was A&O x 4. I didn't get in a lot of trouble, just a wrist slap.

[iamyourgod]

You should always transport these patients:

1. They are altered, so any signature you obtain is worthless.

2. You have no idea what their BA level is.

3. The babysitter you assign is probably also intoxicated.

4. You have no idea what other drugs have been ingested, including prescription or illegal drugs.

5. Often times they are minors, which could put you in a child neglect situation -- the question would be, if we presented 1000 other medics with this scenario, would the majority of them have transported.

[Eydawn]

Let's look at this another way. Someone is jogging and they sprain their ankle. They've been up for 24 hours and were planning to hit the sack after the run. They are AAOX4, but they are definitely not as coherent or competent as they would be had they had a full night's sleep before seeing you. Let's assume, for the sake of debate, that we all agree that fatigue leads to a decrease in competency but not necessarily to the point where someone is not alert, awake and oriented as we define it in our protocols.

1. They are altered. But they are AAOX4. How do we define altered? Is their signature invalid because they're altered from being tired?

2. I have no idea what their BA level might be. Far as I know, they could have had three glasses of wine 7 hours ago and still have alcohol in their system... does that mean I make my judgment on their capability to refuse based on what I see, or on the hypothetical number I can't test for?

3. The friend I'm releasing them to is probably also tired. WTF? If the friend is competent then what does it matter? As long as the friend is also AAOX4 then why should their being tired be an issue?

4. You have no idea what other drugs this patient may have taken. Could be they've had 6 caffiene uppers and are just coming off of that. They could be taking vicodin for back pain. They could have taken a hit of cocaine and that's why they've been awake for so long. Since patients lie and never tell us exactly what they've taken, should we assume that every patient is on drugs? Tired patients must be on drugs, because they're tired. Drunk patients must have taken other drugs because they're drunk.

5. If the patient is a MINOR, read legal minor rather than underage drinker (who can be a legal adult but not old enough to drink alcohol) then there is no issue- you transport regardless. Anyone who turfs someone who is under 18 is an IDIOT. That shouldn't even factor into this discussion, because that's not what was originally being discussed.

Alright... so... who's with me here. Does being tired also mean automatically that you're incompetent? No? Seem far-fetched? Then how does ingestion of any amount of alcohol, no matter how minute, automatically mean that you're incompetent?

Answer me that and I'll get back to taking notes in my microbio class, lol...

Wendy

CO EMT-B

[reaper]

I agree Wendy,

Ever pt is different and you cannot use a blanket protocol on them. This is a on scene judgment decision.

The pt may have had half a drink and got an upset stomach, so they started throwing up.

I do a full evaluation on every pt, then make my decision on whether I let them refuse or not. Just because someone had a drink, does not make their signature useless. If that is the case you might want to transport all Pt's, because half of this country could have ETOH in their system at any time! :roll:

[iamyourgod]

I agree, every call is different, and you have to use judgement --- but the answer to your arguement is this question --- the pt died, and you are now in court -- how do you defend your action ? If you can defend it successfully, fine. If on this call or any other call, you can not reasonable defend your decision to leave them behind, you should transport. Is it reasonable to deem someone safe to delay treatment based on b/p, pulse, and respiratory rate ? Would an ER doc back you up on your decision ?

[Eydawn]

*HEADDESK*

:roll: :roll: :roll:

Why don't you address the questions I ask? Do I smell funny? Discussion involves refuting points given by others, which you continue to fail to do, just adding "Yea but if they die THEN what smarty-pants," which makes you sound like a 4 year old. Whatever they put in your coffee out there, I think I'll pass....

Wendy

CO EMT-B

[Arizonaffcep]

You should always transport these patients:

1. They are altered, so any signature you obtain is worthless.

2. You have no idea what their BA level is.

3. The babysitter you assign is probably also intoxicated.

4. You have no idea what other drugs have been ingested, including prescription or illegal drugs.

5. Often times they are minors, which could put you in a child neglect situation -- the question would be, if we presented 1000 other medics with this scenario, would the majority of them have transported.

1. That's the theme of this thread...can u refuse them. He wasn't altered. I agree (although I don't like to admit it) with you on that he (in hind site) should have been transported. If you believe he was altered, what are your department/hospital/personal guidelines that you go by? For me: A&Ox4, able to state they understand what is going on, and the possible consequences, and can carry on a coherent conversation for several minutes.

2. True. But was acting clinically sober. That means no obvious signs of intoxication. Steady, normal (for the Pt) gait, no slurred speech, no "fruity odor" on their breath, and a normal FSBS. If you go into the ED these days, more and more will you see on intoxicated people that the DR's DO NOT run BALs. This is for a myriad of reasons, but it is so they can say when they are "clinically sober" that they can be discharged. Also, Pt denied ETOH use.

3. I don't have a babysitting agency I work with. Thus...I don't assign babysitting jobs...

4. True. Can't do it without a tox screen though...and it goes back to "he was acting clinically sober."

5. First, -5 points for suggesting I'm dumb enough to let an unemancipated minor refuse. Second rather irrelevant because the Pt I am talking about was in his 30's.